Open Ankle Fractures: What Predicts Infection? A Multicenter Study

Cooke, Margaret E.; Tornetta, Paul; Firoozabadi, Reza; Vallier, Heather A.; Weinberg, Douglas S.; Alton, Timothy B.; Dillman, Megan R; Westberg, Jerald R.; Schmidt, Andrew H.; Bosse, Michael J.; Leas, Daniel; Archdeacon, Michael T.; Kakazu, Rafael; Nzegwu, Ifeanyi N.; O’Toole, Robert V.; Costales, Timothy; Coale, Max; Mullis, Brian; Usmani, Rashad H.; Egol, Kenneth A.; Kottmeier, Stephen; Sanders, David; Jones, Cliff; Miller, Anna N.; Horwitz, Daniel S.; Kempegowda, Harish; Morshed, Saam; Belaye, Tigist; Teague, David

doi:10.1097/bot.0000000000002293

Cited by 12 publications

(8 citation statements)

References 12 publications

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“…Overall, we found a 2.2% incidence of confirmed FRI, which is consistent with the reported prevalence of surgical site infections in the United States. 1,2,[7][8][9] In this study, we identified social risk factors that were associated with the development of FRI after fracture surgery. Our data suggest that Black and Hispanic populations are more likely to develop FRI after fracture fixation.…”

Section: Discussionmentioning

confidence: 99%

“…Overall, we found a 2.2% incidence of confirmed FRI, which is consistent with the reported prevalence of surgical site infections in the United States. 1,2,7–9…”

Section: Discussionmentioning

confidence: 99%

“…Fracture-related infection (FRI) is an encompassing term that includes a spectrum of conditions ranging from superficial cellulitis, to deep surgical site infection, to chronic osteomyelitis, which occurs as a complication of orthopaedic trauma in up to 3% of patients after fracture but may rise to as high as 30%, depending on the severity of injury and soft tissue involvement. 1,2 In orthopaedic patients, surgical site infections have been associated with an increase in length of hospital stay, rehospitalization rate, and health care expenditure. 3,4 The median cost for treatment of patients with orthopaedic trauma with an FRI ranges from 2 to 6 times that of patients without infection.…”

Section: Introductionmentioning

confidence: 99%

“…5,6 These complications can cause lasting damage to a recovering patient. 1 Although infection after fracture repair is notoriously difficult to diagnose and can lead to catastrophic complications, it was only recently that a consensus definition of FRI was published. 7 Furthermore, a systematic review of the literature on randomized control trials in fracture care which used the term "infection" revealed that only 2% used any kind of definition of infection.…”

Section: Introductionmentioning

confidence: 99%

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Factors Associated With the Development of a Confirmed Fracture-Related Infection

Solasz

Merrell

Ganta

et al. 2023

Journal of Orthopaedic Trauma

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Objectives: To identify factors associated with the development of fracture-related infection (FRI) in patients who have undergone operative fixation of their fracture. Design: Retrospective study. Setting: Academic medical center. Patients/Participants: Patients with peripheral extremity long-bone fractures and shoulder and pelvic girdle fractures who underwent operative repair. This included patients who had undergone fixation inside and outside of our institution. Intervention: Chi-square, Fisher exact testing, analysis of variance (ANOVA), and t tests were used for analysis of data, as appropriate. Binomial logistic regression analysis was performed to determine risk factors of FRI. Main Outcome Measurements: Demographics, fracture location, injury mechanism, open wound status, and wound complication type. Results: One hundred ninety-three patients comprised the FRI cohort. Of those with confirmed signs of FRI, 36 (18.7%) had wound breakdown to bone or implant, 120 (62.1%) had a sinus track, and 170 patients (88.1%) had the confirmed presence of microorganisms in deep tissue samples obtained during operative intervention. Factors associated with development of an FRI were as follows: higher BMI; being of Black and Hispanic race; higher American Society of Anesthesiologists class; history of tobacco, alcohol, and drug use; and fractures of the lower extremity (foot, tibia, and femur/pelvis). The results of binary logistic regression demonstrated that treatment at an urban level I trauma center and drug use positively predicted the development of FRI. Conclusion: Our results demonstrate that higher BMI; being of Black or Hispanic race; higher American Society of Anesthesiologists; history of tobacco, alcohol, and drug use; and fractures of the foot, tibia, and femur/pelvis are all factors associated with development of FRI. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

“…Overall, we found a 2.2% incidence of confirmed FRI, which is consistent with the reported prevalence of surgical site infections in the United States. 1,2,7–9…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Factors Associated With the Development of a Confirmed Fracture-Related Infection

Solasz

Merrell

Ganta

et al. 2023

Journal of Orthopaedic Trauma

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“…7 Additional studies have identified predictors of poor outcomes following ankle fractures including increased age, body mass index (BMI) >30, high American Society of Anesthesiologists score, male sex, smoking status, history of diabetes, immunosuppressant use, severity of fracture, and time to wound closure. 7,8,13,18,29,31 Although studies have shown the impact of CKD and the associated bone disturbance on outcomes associated with other traumatic fractures, there is a scarcity of literature describing the effect of CKD on outcomes of ankle fractures. This study will examine the impact of CKD on clinical outcomes following torsional ankle fracture, including complications and unplanned surgical procedures.…”

Section: Introductionmentioning

confidence: 99%

Association of Chronic Kidney Disease and Complications Following Acute Torsional Ankle Fracture

et al. 2022

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Background: Although chronic kidney disease (CKD) has been associated with poor outcomes following traumatic fractures, there is a scarcity of literature describing the effect on outcomes of ankle fractures. We will examine the impact of CKD on clinical outcomes following torsional ankle fracture, including complications and unplanned surgical procedures. Methods: A retrospective review of 1981 adult patients with torsional ankle fractures treated at a level 1 trauma center was performed to identify patients with CKD based on glomerular filtration rate. Demographic, injury, and treatment-related characteristics were collected. Outcomes included any unplanned procedure: implant removal, debridement, revision, arthrodesis, and amputation; in addition to complications of superficial infection, deep infection, and implant irritation. Patients with CKD were matched with patients without CKD by propensity score matching. Univariate comparisons between groups were conducted using chi-square and Mann-Whitney U tests. Results: 136 patients (68 with CKD and 68 without CKD) were analyzed. Of the 68 patients with CKD, the mean stage of disease was 3.7 with 24% on dialysis for a mean length of 4.1 years. Patients without CKD were more likely to undergo primary ORIF (100% vs 54%, P < .001). Thirty-five percent of patients with CKD had surgical complications vs 19% in the cohort without ( P = .07). Patients with open fractures, dislocation, and chronic kidney disease were, respectively, 5.19, 3.77, and 3.91 times more likely to have any complication ( P = .02, P = .05, P = .05). Patients with CKD were more likely to undergo unplanned arthrodesis ( P = .01). Only dislocation was an independent predictor for unplanned procedure (odds ratio = 5.08, P = .026). Conclusion: Following torsional ankle fracture, CKD is associated with increased likelihood of having a complication or an unplanned arthrodesis. Open fractures and dislocation at time of injury are also associated with complications. Our findings encourage caution about surgical treatment of ankle fractures in patients with CKD. Level of Evidence: Level III, retrospective, comparative, prognostic.

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The economic impact of open lower limb fractures in the Netherlands: a cost-of-illness study

Noorlander-Borgdorff,

Kievit,

Giannakópoulos

et al. 2024

Eur J Trauma Emerg Surg

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Purpose To estimate the one-year sum of direct costs related to open lower limb fracture treatment in an academic setting in the Netherlands. The secondary objective was to estimate the impact of deep infection and nonunion on one-year total direct costs. Methods A multi-center, retrospective cost analysis of open lower limb fractures treated in an academic setting in the Netherlands, between 1 January 2017 and 31 December 2018, was conducted. The costing methodology was based on patient level aggregation using a bottom-up approach. A multiple linear regression model was used to predict the total costs based on Fracture-related-infections, multitrauma, intensive care unit (ICU) admission, Gustilo-Anderson grade and nonunion. Results Overall, 70 fractures were included for analysis, the majority Gustilo-Anderson grade III fractures (57%). Median (IQR) one-year hospital costs were €31,258 (20,812–58,217). Costs were primarily attributed to the length of hospital stay (58%) and surgical procedures (30%). The median length of stay was 16 days, with an increase to 50 days in Fracture-related infections. Subsequent costs (46,075 [25,891–74,938] vs. 15,244 [8970–30,173]; p = 0.002), and total hospital costs (90,862 [52,868–125,004] vs. 29,297 [21,784–40,677]; p < 0.001) were significantly higher for infected cases. It was found that Fracture-related infection, multitrauma, and Gustilo-Anderson grade IIIA-C fractures were significant predictors of increased costs. Conclusion In treatment of open lower limb fractures, deep infection, higher Gustilo-Anderson classification, and multitrauma significantly increase direct hospital costs. Considering the impact of infection on morbidity and total healthcare costs, future research should focus on preventing Fracture-related infections.

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Open Ankle Fractures: What Predicts Infection? A Multicenter Study

Cited by 12 publications

References 12 publications

Factors Associated With the Development of a Confirmed Fracture-Related Infection

Factors Associated With the Development of a Confirmed Fracture-Related Infection

Association of Chronic Kidney Disease and Complications Following Acute Torsional Ankle Fracture

The economic impact of open lower limb fractures in the Netherlands: a cost-of-illness study

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